Supplement article
Anaphylaxis in the Young Adult Population

https://doi.org/10.1016/j.amjmed.2013.09.010Get rights and content

Abstract

It is critical that clinicians treating young adults understand the presentation and management of anaphylaxis. The most common trigger for anaphylaxis in this population is food. The prevalence of food allergy is growing, with 8% of US children and adolescents affected. All patients at risk for anaphylaxis should be prescribed epinephrine autoinjectors, as epinephrine is the only life-saving medication for a severe anaphylactic reaction. The presentation of anaphylaxis can involve multiple organ systems (eg, mucocutaneous, respiratory, cardiovascular, gastrointestinal) and, as such, patient education is needed to assist in prompt recognition. Appropriate training of patients and caregivers about how to identify anaphylaxis and what to do in an emergency is critical. Training of school and college staff also is essential, as 1 in 4 first-time reactions occurs outside the home. Additional counseling for adolescents at risk for anaphylactic reactions should address increased risk-taking behavior, decreased adult supervision, dating, and the transition of disease management from an adult to the patient.

Section snippets

Epidemiology and Impact

Anaphylaxis is defined as “a severe, potentially fatal, systemic allergic reaction that occurs suddenly after contact with an allergy-causing substance.”11 Several studies have shown increases in the incidence of anaphylaxis in the population at large.3, 12, 13, 14, 15, 16 Common triggers include foods, drugs, chemicals, insect venom, and exercise. The top 8 food allergens associated with anaphylaxis are peanuts, cow's milk, shellfish, tree nuts, eggs, fin fish, wheat, and soy.17 Common

Signs and Symptoms

Signs and symptoms of anaphylaxis primarily involve the mucocutaneous, respiratory, cardiovascular, and gastrointestinal systems (Figure 2).9, 29, 30, 31 The National Institute of Allergy and Infectious Diseases (NIAID) and the Food Allergy and Anaphylaxis Network (FAAN) have developed diagnostic criteria for food-induced anaphylaxis,11 as discussed in more detail in the earlier article in this supplement by Dr Phillip Lieberman.32 (Note: As of November 12, 2012, FAAN merged with the Food

Management

The management strategy discussed earlier in this supplement32 and general treatment guidelines are often not easily translated into clinical practice in young adults. A recent chart review conducted at 3 clinics in the Chicago area revealed a stark difference between developing and disseminating guidelines and actually implementing guidelines into clinical practice. For example, only 55% of charts documented prescription of an epinephrine autoinjector, 33% of charts documented patient

Conclusions

The rate of anaphylaxis is increasing in adolescents and young adults. Proper diagnosis and management are critical, as is counseling and education for this special population. All adolescents should be educated about signs and symptoms of anaphylaxis and how and when to use an epinephrine autoinjector. Increased risk-taking behaviors, dating, and transitioning care from adults to patients, among other factors, must be addressed. Management strategies also must be followed in public places

Acknowledgments

This article is based on a presentation authored and delivered by Ruchi S. Gupta, MD, MPH, at the multidisciplinary Partnership for Anaphylaxis Round Table meeting, held in November 2012, in Dallas, Texas. The round table meeting was supported by Mylan Specialty L.P. Medical writing and editorial assistance for the preparation of this manuscript were provided by Jeff Kuper, PharmD, of PharmaWrite, LLC, and were funded by Mylan Specialty L.P. This manuscript is an original work and was prepared

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      Consumers also rely on accurate information about potentially allergenic ingredients in unpackaged foods and food eaten in food service settings. However, the accuracy of information available to food-allergic consumers remains inconsistent, and accidental exposures to allergens in packaged food and food eaten away from home are common6-9 and potentially life-threatening. Given these gaps in practice, mandatory labeling of common food allergens (peanuts, tree nuts, milk, eggs, sesame, fish, crustaceans, soy, and cereals containing gluten) was first introduced in Australia and New Zealand in 2002 by Food Standards Australia New Zealand (FSANZ) via the Food Standards Code (FSC),10 with lupin added in 2017.

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    Funding: This work was supported by Mylan Specialty L.P.

    Conflict of Interest: Ruchi S. Gupta, MD, MPH has served as an advisor and speaker for Mylan Specialty L.P.; she received an honorarium from Mylan for attending the Partnership for Anaphylaxis Round Table. No payment was received for writing of this manuscript. Dr Gupta has received research support from the National Institutes of Health, Mylan, and FARE.

    Authorship: Dr Gupta fully qualifies for authorship of the manuscript, having made substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work; and the identification and interpretation of the appropriate published literature. She was involved in drafting and critically revising the manuscript for important intellectual content, reviewed the final manuscript, and gave approval for submission. Dr Gupta is accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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